11D2265870 CLIA NUMBER - WEST ATLANTA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 11D2265870
  • Facility Name: WEST ATLANTA PRIMARY CARE
  • Facility Address: 4904 TIMBER RIDGE DRIVE, SUITE 102
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 678 401-4597
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHIVAM DESAI
  • NPI Number: 1629724752
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2265870
LAB Type Physician Office
Facility Name WEST ATLANTA PRIMARY CARE
Street 4904 TIMBER RIDGE DRIVE, SUITE 102
City DOUGLASVILLE
State GA
ZIP 30135
Phone 678 401-4597
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2024
Certificate Expiration Date 8/2/2026
Facility Type Physician Office
Lab Director SHIVAM DESAI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025